Healthcare Provider Details

I. General information

NPI: 1487482626
Provider Name (Legal Business Name): MRS. LA'KISHA PROPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49393 AU LAC DR E
CHESTERFIELD MI
48051-2420
US

IV. Provider business mailing address

49393 AU LAC DR E
CHESTERFIELD MI
48051-2420
US

V. Phone/Fax

Practice location:
  • Phone: 586-231-4232
  • Fax:
Mailing address:
  • Phone: 586-231-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: